Alex wrote the daily blog on Bookbrunch.co.uk for 16 May 2022.
“A Testimony From The Red Zone”
Dermatologist Alex Anstey on how he and his colleagues have tried to cope in ‘our much-loved but cash-strapped’ health service.
Full text of article
“The latest survey of British Social Attitudes reports that 94% of the British population support the concept of an NHS free at the point of delivery, and 86% think it should continue to be funded by taxation. They’re reassuring scores for those of us who work in healthcare, suggesting an ongoing and deep commitment to the basic concept of the NHS. More worrying, however, is the 36% satisfaction rate, the lowest level recorded since 1997. Despite the deep national affection for the NHS, people realise that something significant has gone wrong.
In 2006 the GP Dr Julian Tudor Hart published The Political Economy of Health Care: A Clinical Perspective. He was nearing the end of his life, and was expressing dismay at the creeping privatisation of the NHS: “They have had to do so by stealth,” he said, “proclaiming each successive capitulation to commerce as support for otherwise declining NHS standards… No open electoral battle has ever been fought, but the slide back to the market continues, driven by its own idiot logic of the bottom line, where profit stands proxy for every other outcome.”
I was motivated to write about the decline of the NHS over the last 15 years by my experiences as a senior NHS doctor. My book, Under The Skin: A Dermatologist’s Fight To Save the NHS, describes the NHS austerity years that followed soon after Tudor Hart’s book was published, when health service funding was restrained like never before, at the very moment when a market economy was introduced for the NHS in England. Tudor Hart would have hated it. And then, in 2020, came the ultimate test: how would the NHS perform in the face of a global pandemic following years of decline? Badly, is the short answer.
I wrote Under the Skin because I felt passionately about the NHS and could not accept what was happening to it. We NHS staff know there are significant problems: long-term under-funding and long-standing staff shortages have taken their toll. We also recognise that the NHS has lost its lofty position as a health service once globally admired; not many NHS clinical staff currently believe that our way of doing healthcare is world-beating, the best, to be copied and emulated. It is now we who are casting around, searching for answers to learn where we have gone wrong and to start playing catch-up.
Our politicians have let us down, the nation denied a rational debate. Health and social care have been reduced to soundbites at election time such as “The NHS is safe in our hands”, or “350 million pounds per week for the NHS”, or “We will build 40 new hospitals”. The reality is that most NHS consultants that I know regard the NHS as being in the red zone: there is little spare capacity and most services are running on empty.
Under the Skin describes how we responded locally in North Wales to a failing NHS service for dermatology. With no extra funding, we created a new way of working, with specialists and generalists teaming up. We called this new system “Dermatology Integrated Care”. Did it work? The waiting lists came tumbling down, demand for private referrals dried up, the health care teams enjoyed working together, and patient satisfaction was high. Furthermore, this new system performed well in the pandemic, the changes tried and tested over the previous 18 months.
However, doing more with not enough is ultimately an empty philosophy that short-changes patient care. We needed investment into this new way of working, to nurture and sustain it, and defend it against attacks from those who were reluctant to adopt it. Sadly, that investment was not forthcoming in our much-loved but cash-strapped NHS.
To quote Tudor Hart, back in 2006, “We need a new big picture of where we have come from, where we want to go, and how we can get there.” I hope my book will provide useful insights to contribute to the debate on the future of health care in the UK as we seek to reverse years of decline and help to restore the NHS to its former glory. Under the Skin is written from personal experience: the events described actually happened. They are, of course, my version of these events, and others may disagree with what I remember and how I have interpreted it. I have done my best to be candid and to treat the truth with respect. My intention was to create something worthwhile and authentic that would resonate with readers, and stand the test of time.
I have also based my own opinions and hypotheses on expert opinion. The book includes 10 experts and influencers, each of whom offered me valuable insights that I have adoptied and adapted for my own situation: Cadwaladr, Jenner, Osler, Cochrane, Tudor Hart, Bevan, Lloyd George, Christensen, Berwick and Osier. Their amazing stories are included in Under the Skin, and vividly illuminate the text; eight men and two women, two of whom are still alive. The two women more than hold their own, emerging as the brightest stars from this stellar group.
There are also patients’ stories. Ultimately, health care is all about the patients. If we lose sight of this fact, all is lost. Who better to bring the topic of healthcare alive? As someone who has devoted his working life to the NHS, and who still believes passionately in the concept, I hope that my views will not go unheeded. My ambition with this book is more modest than offering solutions: I aim only to contribute to the debate that must now come if the NHS is to regain its position of pre-eminence.”
Under the Skin: A Dermatologist’s Fight To Save the NHS will be out from Whitefox on 19 May.
Alex Anstey 